The main objective of the proposed study is to determine the degree to which adverse newborn outcomes related to prenatal drug use are the result of the drugs versus associated social and psychosocial factors. The study also will include an evaluation of the neighborhood and individual level influences on both drug use and birth outcomes. The specific aims are 1) To evaluate the impact of prenatal drug use on neonatal outcomes and the degree to which associated individual level social, psychosocial, behavioral, and biomedical factors account for the observed relation 2) To determine the influence of neighborhood characteristics on prenatal drug use, above and beyond the personal characteristics of women, and evaluate pathways through psychosocial factors and 3) To examine the impact of prenatal drug use on birth outcomes independent of neighborhood conditions, and whether drug use mediates or moderates neighborhood effects on birth outcomes. The proposed study will identify both individual and contextual factors that should be addressed in treatment and prevention strategies that intend to improve newborn outcomes. Data are from a study of urban, low-income women delivering at a major teaching hospital. Drug use was determined by medical records, self-report, and a universal urine screen at admission to labor and delivery. A postpartum interview gathered detailed information on a variety of social, psychosocial and behavioral characteristics. Residential census tract information will be linked with participant medical and survey data to incorporate neighborhood characteristics in multilevel models. ^c Relevance This research will: determine the contribution of social, psychosocial, and behavioral factors to the vrisk of adverse newborn,outcomes related to prenatal drug use, and thereby identify the lifestyle factors and social: circumstances in women's lives that must be addressed along with drug use to improve newborn outcomes. The community and individual factors related to drug use during pregnancy will be evaluated to inform effective prevention strategies. [unreadable] [unreadable]